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Diabetes Mellitus Type 2Published by: Domus Medica | SSMGLast published: 2017Diabète sucré de type 2Published by: SSMG | Domus MedicaLast published: 2017

Although the life expectancy of those with type 2 diabetes is improving in many high-income countries, the burden of the disease remains high.[282]

Diabetes increases the likelihood of major cardiovascular events and death; the increased risk is variable across patients depending on age at diabetes onset, duration of diabetes, glucose control, blood pressure control, lipid control, tobacco control, renal function, microvascular complication status, and other factors. The association of diabetes and increased mortality can be attenuated by cardiovascular risk factor control.[283] A HbA1c of 6% to 6.9% (42-52 mmol/mol) is associated with the lowest mortality.[283] Trends in data for complications in people with diabetes show a declining risk of cardiovascular disease (CVD) and CVD-associated mortality, particularly in high-income countries.[284] When type 2 diabetes is diagnosed at age 40, men lose an average of 5.8 years of life, and women lose an average of 6.8 years of life.[14] The overall excess mortality in those with type 2 diabetes is around 15% higher, but ranges from ≥60% higher in younger adults with poor glucose control and impaired renal function, to better than those without diabetes for those who are age 65 and over with good glucose control and no renal impairment.[9][10]

Diabetic retinopathy is the most common cause of blindness in people of working age in England, Wales, and Scotland.[285] About 12% to 19% of people with type 2 diabetes have some diabetic retinopathy already at the time of diagnosis; 4% develop proliferative retinopathy after 20 years or more of diabetes.[286] Chronic kidney disease occurs in about 40% of patients with type 2 diabetes over time.[166]​ Diabetes is a leading cause of end-stage renal disease; however, incidence rates of ESRD attributed to diabetes are declining; continued intervention to detect and manage diabetic kidney disease is required to limit the development of ESRD.[287]

A sustained return to normal/nearly normal glucose levels in patients with type 2 diabetes can be achieved; however, the frequency, duration, and effect on medical outcomes remain unclear, and further investigations are required. To facilitate research efforts, the European Association for the Study of Diabetes recommends that this sustained metabolic improvement should be referred to as remission, and defined as a return of HbA1c to <6.5% (<48 mmol/mol) that occurs spontaneously or following an intervention and that persists for at least 3 months in the absence of usual glucose-lowering pharmacotherapy.[288] 

Effective treatment requires a motivated and informed patient who actively takes responsibility for the care of their diabetes, and a clinical team willing to frequently adjust medications to support comprehensive disease management over a long period of time. With the right care and support, people living with diabetes can lead healthy, productive lives.

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